Medicare, explained in plain language.
Whether you are choosing coverage for the first time or wondering if your current plan still fits, I'll help you compare your options and understand what you are signing up for.
Three kinds of Medicare coverage.
Each one works with Original Medicare in a different way.
Medicare Advantage
Also called Part C. A private plan that replaces Original Medicare as the way you get your Part A and Part B benefits. Most include drug coverage, and many add extra benefits.
Medicare Supplement
Also called Medigap. A private policy that works alongside Original Medicare and helps pay costs it leaves to you, such as copayments, coinsurance, and deductibles.
Prescription drug plans
Part D. Stand-alone drug coverage you add to Original Medicare. Each plan has its own list of covered medications, so yours need to be checked against it.
Two ways to set up your coverage.
Most people end up on one of these two paths. Here is how they differ in practice.
Original Medicare plus a Supplement
Parts A and B, a Medigap policy, and a Part D drug plan
- Who runs it
- The federal government runs Original Medicare. Private insurers provide the Supplement and the drug plan.
- Choosing doctors
- Any doctor or hospital in the U.S. that accepts Medicare. Referrals are generally not required.
- What you pay
- Typically a higher monthly premium for the Supplement, in exchange for lower and more predictable costs when you need care.
- Prescriptions
- Covered through a separate Part D plan.
- Dental, vision, hearing
- Most routine care is not covered. You can add separate coverage.
Medicare Advantage
One private plan that combines Parts A and B, and usually D
- Who runs it
- A private insurer approved by Medicare. You are still in the Medicare program.
- Choosing doctors
- Many plans use a provider network, and some require referrals to see specialists.
- What you pay
- Often a lower monthly premium, with copayments as you use care and a yearly limit on out-of-pocket costs for covered services.
- Prescriptions
- Included in most plans.
- Dental, vision, hearing
- Some plans include extra benefits. What is covered varies from plan to plan.
You keep paying your Part B premium on either path. Costs, networks, and benefits vary by plan and by where you live, which is why a side by side review of your own situation matters.
A review built around three things.
The right plan on paper is the wrong plan if your doctor is not in it. So we start with your life, not a brochure.
Your doctors.
We check which options work with the doctors, specialists, and hospitals you want to keep.
Your prescriptions.
We look at how each option covers the medications you take, at the pharmacy you use.
Your budget.
We compare what you would pay each month against what you could pay when you need care.
When you can enroll or make a change.
Medicare only lets you make changes at certain times. Fall is the big one, when Open Enrollment runs from October 15 to December 7.
Initial Enrollment Period
Around your 65th birthdayA seven month window that starts three months before the month you turn 65. See how the window works.
Open Enrollment
October 15 to December 7Each fall you can switch between Original Medicare and Medicare Advantage, or change your Advantage or drug plan. Changes take effect January 1.
Medicare Advantage Open Enrollment
January 1 to March 31If you are already in a Medicare Advantage plan, you can switch to a different one or return to Original Medicare, one time.
Special Enrollment Periods
After certain life eventsMoving out of your plan's area or losing other coverage, among other events, can open a window to make changes outside the usual dates.
Medicare Supplement Open Enrollment
Six months, one timeStarts the month you are 65 or older and enrolled in Part B. During it, insurers cannot turn you down or charge more because of your health.
General Enrollment Period
January 1 to March 31For people who missed their first window to sign up for Medicare Part A and Part B and do not qualify for a Special Enrollment Period. Coverage starts the month after you sign up, and a late penalty may apply.
Prefer to look around first?
You can browse Medicare plans available in your area on your own, then bring me your questions.
Find out whether your
coverage still fits.
Book a time and bring your list of doctors and prescriptions. We will go through it together.